Sunday, June 2, 2013

Prevent Alzheimer’s by Learning to Play Musical Instruments

One of our
previous posts was wholly devoted to the Music
Therapy, and its positive effect on the Alzheimer’s patients on all studies
of the disease, but at various degrees. However, scientists made a new
discovery, confirming that active participation in the Music Therapy may be
even more useful in process of prevention and delaying onset of visible and perceived
symptoms, even when negative chemical processes in the brain are already
ongoing.

Playing Music and Alzheimer’s

Research has
indicated that learning a musical instrument may help prevent Alzheimer’s
disease. Music and cognition are inexorably linked; we know that
perceiving and creating music require complex neural (brain) activity.
Alzheimer’s disease is characterized by a loss of neurons and the connections
between them. Interestingly, a clinical study showed that older adults who
were more active, including those who played an instrument, were less likely to
develop Alzheimer’s disease than less active older adults. The cognition
involved in learning to play an instrument fosters the growth and strength of
the brain’s neural network, and as such can act as a deterrent for Alzheimer’s
disease as well as other forms of dementia.

Other research
with Alzheimer’s patients further elucidates the relationship between cognition
and music. The most recognizable trait of Alzheimer’s disease is memory
loss. However, studies have shown that the ability to play an instrument
may be spared by Alzheimer’s disease; some musicians with the disorder retain
the ability to play their instrument, even if they are unable to learn new
songs or identify familiar melodies. Further, it has been suggested that
Alzheimer’s disease exists to a lesser degree among musicians (specifically,
orchestral musicians) than among non-musicians.

One study showed
that incorporating music into a memory task helped Alzheimer’s patients to
remember, while it had no discernable effect on the memory of healthy
participants. Similar correlations between music and increased cognitive
functioning have been observed in stroke victims who suffer from aphasia (those
who have trouble understanding or producing language). The connections
between music and cognition run deep and we still have a lot to learn.
But one thing we are pretty certain of is that the experience of learning how
to play an instrument acts as a buffer against cognitive decline—particularly
Alzheimer’s disease. So, if you are a musician—great! If you are
not a musician, you should give it a try!

Emory University's Department of Neurology Study, 2010

Children who
learn to play a musical instrument and keep playing for many years will enjoy a
better brain when they age. Not only will they retain cognitive skills that
others may lose, they may enjoy special protections against some effects of
Alzheimer's disease, according to a study conducted by Brenda Hanna-Pladdy, PhD.,
a clinical neuropsychologist in Emory University's Department of Neurology.

"Natural
aging of the brain and the effects of the more accelerated decline found in
neurodegenerative conditions such as Alzheimer's Disease may be delayed or
diminished,” said Hanna-Pladdy.

Her study used a
comprehensive battery of neuropsychological tests on individuals age 63 to 80.
Those with more than ten years of experience playing a musical instrument
performed best in tests. Those with less than ten years experience score lower.
Those with no experience tested lowest. Subjects were tested on spatial memory,
naming objects, and cognitive flexibility, the brain's ability to adapt to new
information. These abilities typically decline as the brain ages or affected by
conditions such as Alzheimer's disease

In her continuing
research at Emory, Hanna-Pladdy is using functional MRI brain imaging done
during cognitive testing to show the intensity and location of brain activity,
demonstrating the differences between those with significant musical training
and those with little or no such training.

"Based on
previous research and our study results, we believe that both the years of
musical participation and the age of acquisition are critical,"
Hanna-Pladdy said. "There are crucial periods (during childhood) in when
brain plasticity can enhance learning, which may make it easier to learn a
musical instrument before a certain age, and thus may have a larger impact on
brain development that could compensate for cognitive declines as we get
older."

University of
Central Florida Study, 2012

While the
previous study addressed the therapeutic effectiveness of playing musical
instruments to prevent the disease, this study has been directed to the people
who are already affected. For the study, William Kang, a third-year medical
student at the University of Central Florida in Orlando, divided a cohort of 15
patients with Alzheimer's disease into 2 groups: a control group of 7 patients
who received biweekly sessions of "passive" music therapy, involving
only listening to violin music; and an intervention group of 8 patients who
received biweekly sessions of instructional violin lessons in addition to the
passive music therapy.

None of the
patients had played the violin before. The lessons were taught by Kang, who is
himself a former professional violinist. Four of the patients, with Mini-Mental
State Exam (MMSE) scores ranging from 7 (severe impairment) to 28 (mild
impairment), were able to learn skills including plucking strings and holding
the bow with assistance, 2 were able to produce sound, and 1, with an MMSE
score of 22, was able to learn to play the song Twinkle, Twinkle, Little Star.

Although
qualitative results between the 2 groups after 8 weeks were not statistically
significant, Kang said several observations were striking. For one thing, the
results indicated that patients in the intervention group were capable of
learning the violin. "We learned that Alzheimer's disease patients can
learn to play the violin. Even someone with the [MMSE] score of less than 15
was able to it learn it to a certain extent."

Second, those
learning the violin demonstrated improved abilities in relation to everyday
tasks such as remembering names and faces. In the most dramatic example, one
patient recalled the name of a nurse she'd long forgotten."She'd had the
same nurse for 10 years but could never remember the nurse's name, but after
just 3 weeks of learning to play the violin, she greeted the nurse one morning
by her name," Kang said.

Third, the
patients who received violin lessons showed observable improvements in mood,
memory, and cognition. "The nurses, families, physicians, and I observed
improvements in mood and energy and decreases in agitation," Kang said. "Patients
who had sundowners syndrome and were out of control, for instance, were able to
calm down and improve cognitively after just 8 weeks, which is a relatively
short time."

Kang noted that
previous studies involving music therapy with Alzheimer's patients have
involved more basic responses, such as listening, clapping, and following a
rhythm, but he is not aware of any other research evaluating the effects of
learning to play a complex musical instrument. He speculated that the nature of
the violin itself could be an important part of the equation, providing
different challenges than, perhaps, learning to play a saxophone.

"I think the
difficulty of the violin is the most important asset," Kang said. "If
you think of the violin, you're using aural, visual, vibration sense, pain and
temperature sense, proprioperception, and an emotional sense."

"Every song
they play has an emotional quality. Previous studies have even shown increases
in the corpus callosum, connecting the left and right cerebral hemispheres, in
relation to music," he explained.

Famed neurologist
and author Oliver Sacks, MD, has written extensively on the profound and
fascinating way that music resonates with dementia and Alzheimer's patients.

According to
psychiatrist Angela Scicutella, MD, PhD, associate professor of psychiatry and
behavioral sciences at Albert Einstein College of Medicine, in the Bronx, New
York, and a member of the American Academy of Neurology, one reason Alzheimer's
patients respond to music might be that the part of the brain that understands
music is not the first target of the disease. "The processing of music is
thought to involve frontal subcortical circuits," said Dr. Scicutella. "The
orbitofrontal cortex is important in social interactions, and the medial
prefrontal cortex is important in attention and motivation of human behavior. These
areas, which are more involved in the emotional aspects of human behavior, are
usually preserved until later in the course of Alzheimer's dementia, as opposed
to the hippocampus and entorhinal cortex, which are involved in factual memory
and are the first areas to be affected by the pathology of Alzheimer's disease.
Therefore, these cortical/subcortical circuits, which tap into brain areas that
are relatively preserved, can serve as another route for learning."

Music has a
unique ability to engage patients on multiple levels, which makes it highly
useful on a therapeutic level, she added.

"Music may
be able to benefit Alzheimer's patients because it increases arousal and
attention, which may help them to encode information and improve their recall
of that information."

Dr. Scicutella
explained that using music as a participatory exercise is often beneficial,
whether it's learning to play an instrument or just singing some favorite old
songs. "I would suggest engaging the patient in whatever music that the
person liked prior to the diagnosis of dementia or music that was popular in
their youth/teenage years/early 20s," she said. "Engaging patients in
active participation, such as a sing-a-long or playing a simple instrument like
cymbals or drums is preferable to passive activities, where they are just
sitting in an audience listening to music."